How Therapists Can Survive the Pre-Licensure Desert

Dr. David Hall is a Licensed Marriage and Family Therapist and Licensed Professional Counselor-Mental Health Service Provider-Approved Supervisor in the state of Tennessee. In this article (originally published on PsychMaven), David shares his pre-licensure experience, some of the pitfalls to avoid, and tips to make your own journey through the desert a successful one.

In 2006, I completed my Master’s in Marriage and Family Therapy, and began what is, for many of us, a professional journey across the desert. I had put in hard work to earn my degree and hone my clinical skills, I even had a job post-graduation, but my academic coursework didn’t prepare me for what was to come next and I, admittedly, assumed that since my professors weren’t talking about it, it couldn’t be that hard!

I was out on my own, not fully understanding my options for supervision or how to best move forward toward licensure. Essentially, I had all my gear ready, but I was in the desert, without a compass and not sure which direction to go.

Looking back, I’ve been able to identify three key things that contributed to my successful journey through pre-licensure and which also provided some much needed oases along the way: Quality supervision, keeping my long-term goal in sight, and what I call “finding your tribe.”

David with his brother and grandmother at his graduation.

The Importance of Quality Supervision

Most graduate schools take on the responsibility of matching students with a supervisor during their academic program. After graduation though, the onus is on the new therapist to find a supervisor. Some employers offer supervision as part of an employment agreement, but this isn’t always the case. Additionally, criteria for what counts as qualified supervision varies from state to state. I have consulted with many professionals who have worked for years receiving supervision in a clinical setting, only to find out later that the supervision hours they received did not meet the criteria for licensure.

So, what can you do about it?

The first thing I recommend is to familiarize yourself with the rules and statutes covering your profession in your state. This can feel daunting, and it may be hard to fully interpret, but it’s an absolutely crucial starting point. All state licensing boards publish rules and requirements for licensure on their website and this includes supervision requirements. Knowing the rules for different states can be important as well, particularly if you think you may end up pursuing licensure in another state.

After understanding what the requirements are, the next step is to explore what supervision options you may have locally. The shortfall of qualified supervisors in certain geographic areas has become an acute problem for many people seeking mental health licensure. This is where tele-supervision through Motivo may come in, providing an alternative solution to a critical need in the field. This form of distance supervision eliminates many of the barriers keeping professionals from accruing their supervision hours. While many states and licensing boards have become more open to allowing tele-supervision, you still need to check that it is an approved form of supervision in your state.

Once a new therapist has secured a qualified, competent supervisor, it’s important to stay focused on the next steps to licensure. One does not need to spend a lot of time on job boards to realize that employment opportunities for pre-licensed therapists are often scarce.

Understanding how your state grants licensure, and the types of licenses available is also critical. My experience may be an outlier, but I did not hear a single discussion about associate licensure when I was in graduate school, even though the state of Georgia, where I was studying, offers associate licensure status for both professional counselors and marriage and family therapists. With an associate licensure, you are able to work under your own designation while receiving supervision. Not all states offer this, but it’s something I look back on and wished I had pursued.

Another step I wished I had done differently was related to when I took my required exams – and I’m not alone in this either. Nearly every therapist I have spoken to who waited to take their exam toward the end of their pre-licensure time regrets it and there are a couple reasons why.

One, while you may be ready to take a break from studying and test-taking after you graduate, this is also the time when the material is still fresh in your mind, making studying easier. Two, if you experience any difficulty in passing an exam and need to take it again, you could further delay your licensure process.

This second scenario is one I experienced the hard way. I, admittedly, left one of my required exams until the end of my pre-licensure period and failed the test by a few points. Not only that, but I was required to wait three months before I could sit for it again. I passed on the second try, but this delay cost me 10 months and meant that I had to keep paying for supervision. Had I taken the exam earlier in the process, I could’ve saved quite a bit of time and money.

Finding Your “Tribe”

In a recent conversation with a professional mentor, we discussed different factors that contribute to burnout for people in pre-licensure. A common theme that emerged was one of working in isolation. I know firsthand how integral having my tribe around me was during this time in my career.

When I discuss the importance of finding one’s tribe, I’m referring to something more specific than just a peer group – a tribe is made up of peers, but also chiefs and elders, as well as newer members below you. My personal tribe included peers – students from my grad program and other new clinicians I met through networking – and it also included people ahead of me on my career path – supervisors, professors, and fully licensed therapists. My tribe sustained me through the difficult, often lonely, period of pre-licensure, providing me with a sense of camaraderie, encouragement, and also challenging me to think things through as a professional therapist. A good tribe will provide you both growth and support, but it is up to you to seek it out. A quick tip I give to other new clinicians looking for tribe members is to get involved with professional associations early, particularly on the state and local level.

Today, I’m happy to say that I successfully crossed and survived the desert. Not only am I a licensed clinician, but my experience led me to pay it forward and now I supervise other postgraduate therapists and teach graduate-level and continuing education courses.

Emily Donahue holds a Master's in Mental Health Counseling from Northwestern University. She works as a limited permit therapist at a private practice in Brooklyn, earning her clinical and supervision hours for full licensure. She has a special interest in women and alcohol use and her dream is to meet Irving Yalom one day.

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